Healthcare Provider Details

I. General information

NPI: 1245799204
Provider Name (Legal Business Name): CASEY OBRADOVITCH BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12777 VALLEY VIEW ST STE 121
GARDEN GROVE CA
92845-2521
US

IV. Provider business mailing address

12777 VALLEY VIEW ST STE 121
GARDEN GROVE CA
92845-2521
US

V. Phone/Fax

Practice location:
  • Phone: 714-337-6484
  • Fax: 855-213-2184
Mailing address:
  • Phone: 714-337-6484
  • Fax: 855-213-2184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-47508
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: